Medical Management Specialist I/ PHRN

Elevance Health; Taguig; On-site; PHP 360,000 - 480,000; Full time

Job summary

Elevance Health in Metro Manila is seeking a Medical Management Specialist I/ PHRN to provide non-clinical support to Medical Management and Operations. You will gather case information, refer or assign cases, maintain tracking databases, and prepare reports while coordinating with internal teams.

The role requires a Philippines RN license and about 1 year of administrative and customer service experience, with knowledge of managed care concepts.

Qualifications

• Requires a current Philippines RN license.
• 1 year of administrative and customer service experience.
• Knowledge of managed care or Medicaid/Medicare concepts.
• Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Responsibilities

• Gathers clinical information regarding the case and determines appropriate area to refer or assign case.
• Maintains and updates tracking databases; prepares reports and documents all actions.
• Provides information regarding network providers or general program information when requested.
• May assist with complex cases and act as liaison between Medical Management and internal departments.

Skills

Administrative experience

Customer service

Communication skills

Analytical skills

Problem-solving

Education

Philippines RN license

Job description

Position Title: Medical Management Specialist I/ PHRN

Job Description:

Responsible for providing non-clinical support to the Medical Management and/or Operations areas. Primary duties may include, but are not limited to: Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review). Provides information regarding network providers or general program information when requested. May assist with complex cases. May act as liaison between Medical Management and/or Operations and internal departments. Maintains and updates tracking databases. Prepares reports and documents all actions. Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information. Requires a current Philippines RN license; 1 year of administrative and customer service experience with knowledge of managed care or Medicaid/Medicare concepts; or any combination of education and experience, which would provide an equivalent background. For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.